She said it's a good trait to have if you enter into the profession she's worked in for more than 40 years. She's one of the certified registered nurse anesthetists at Schuylkill Health in Pottsville.

"You absolutely have to be a Type-A," Cook, Pottsville, said Jan. 14.

"Extremely detail-oriented," Jessica Yoder, New Ringgold, another CRNA from Schuylkill Health, said in return.

"I remember my first day of anesthesia school, which was 24 years ago. The one word which was up on the board and which has been engraved in my brain is the word 'vigilance.' A Type-A has to have everything precise. If you have to give 1.256 milligrams of something, you're going to give that amount," Julie Tidmore, Orwigsburg, another CRNA from Schuylkill Health, said Jan. 14.

There are 15 CRNAs at Schuylkill Health, Cook said.

"I think all of us are Type-A personalities," Yoder said.

This week, the hospital campus is encouraging the public to learn a little about the nursing staff who lead patients into la-la land as they're wheeled into surgery, since this is National Nurse Anesthetists Week.

"The idea is to have the patient out before they even get in here. That's the name of the game. Surgery is one of the most stressful things people might deal with in their lifetimes. Our goal is to make sure we take that stress level down. And I always say, if I've done my job right, you won't remember me," Cook said at one of the operating rooms at the Outpatient Surgery Center, Schuylkill Medical Plaza, Pottsville.

"Anesthesia is freedom from pain. Each year, millions of people in the United States undergo some form of medical treatment requiring anesthesia. Anesthesia, in the hands of qualified professionals like Certified Registered Nurse Anesthetists, is a safe and effective means of alleviating pain during nearly every type of medical procedure," according to the website for the American Association of Nurse Anesthetists at aana.com.

"For more than 150 years, nurse anesthetists have been administering anesthesia in all types of surgical cases, using all anesthetic techniques and practicing in every setting in which anesthesia is administered," according to the website.

In the majority of cases, anesthesia is administered by a CRNA, according to the site.

"CRNAs work with your surgeon, dentist or podiatrist, and may work with an anesthesiologist, a physician anesthetist. CRNAs are advanced practice registered nurses with specialized graduate-level education in anesthesiology," according to the website.

"Every patient's different," Tidmore said.

So, the CRNAs keep a close watch on every patient under sedation, constantly checking blood pressure, EKG and skin color, she said.

"You can't just look at one piece of the puzzle. You have to look at the whole picture," Cook said.

"It's a constant, constant, constant checking of what we do," Cook said.

And good CRNAs work to support the physicians during procedures, Yoder said.

"The doctor needs to be able to concentrate on what he's doing and he needs to know that that patient is stable. Our job is to free his mind of that concern or that worry," Cook said.

There are three basic types of anesthesia, according to the website for the AANA:

- General anesthesia produces a loss of sensation throughout the entire body.

"That always has to be present in the emergent situation that we would have to mask-ventilate the patient. We don't always connect a patient to that machine, but it has to be present in the emergency room," Tidmore said.

The machine she referred to releases gases including nitrous oxide and oxygen through a tube to a mask which covers the patient's nose and mouth.

- Intravenous regional anesthesia produces a loss of sensation to a specific region of the body.

- Intravenous local anesthesia produces a loss of sensation to a small specific area of the body.

While Cook said she's doing her job right if her patients don't remember her after a procedure, she said it's important for patients to know that CRNAs are there. She said that's the point of National Nurse Anesthetists Week.

"I had many patients who didn't know who was going to give them anesthesia. They just assume it's the doctors they see. I tell them, 'The doctors they see are involved in the game plan, but I will be with you from the time we start until the time they take you to the recovery room. That is my job, to watch you,' " Cook said.

INFO BOX:

There are questions patients may want to ask their physicians before experiencing anesthesia. "Because responses will be different for each patient, based on medical history and personal characteristics, answers are not provided below. These are some sample questions you should ask your anesthesia provider before having surgery," according to the website for the American Association of Nurse Anesthetists at aana.com.

The questions are:

- Which type of anesthesia is best for me and the surgery I am having?

- What should I avoid eating or drinking before I come in to have my surgery?

- Is it all right to come alone or should someone come with me?

- Which kinds of medications do you need to know I am taking before I am operated on?

- Is it all right to take medications for my allergies before I come in?

- I have asthma, what do I need to know before and after I have surgery?

- I am diabetic, are there any special concerns before or after I have my surgery?

- I take complementary/alternative medicines - will these pose any problems or is it all right to keep taking them before my surgery? What about herbal supplements?

- Will I be able to eat solid foods right after my surgery?

- What if I have more questions after the surgery? Who can I contact?

- My child is having surgery - what do I need to know? How can I help prepare my child for surgery? Will I be able to stay with my child until the anesthesia takes effect?

Source: The website for the American Association of Nurse Anesthetists at aana.com

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